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Health Benefits Claim Form of Health Insurance and

Details: 72 - Rural Health Clinic . 81 - Independent Laboratory . 99 - Other Locations . RELEASE OF INFORMATION If Payment Is To Be Sent Directly To Provider I authorize the release of any medical information necessary to process this claim. I understand that, as permitted by law, to the extent of benefits paid under this claim, the Plan acquires all rights

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Over-the-Counter Health & Wellness Products

Details: Health and Wellness Product Order Form. Your current plan may have an over-the-counter benefit that would allow you to . purchase OTC health and wellness products from Humana Pharmacy. To verify your 2021 Health and Wellness allowance, please contact customer service or check your Summary of Benefits. Keep this catalog somewhere accessible.

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Humana 2021 Health and Wellness Catalog and Order Form

Details: Over-the-Counter (OTC) Health and Wellness Product Catalog Note: You will receive the generic equivalent of all items Antacid, Anti-Diarrheal and Laxatives Product code Product name Compare to Package count Price 032 Antacid/Anti-Gas Liquid Mylanta® 12 oz. $8.00 318 Anti-Diarrheal Caplets - Loperamide 2 mg Imodium® A-D 24 $7.00

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Authorization/Referral Request Form

Details: For behavioral health services, submit fax to 469-913-6941 For same-day appointments or urgent requests, call 800-523-0023. To create a new referral or authorization online, visit Availity.com, which is available 24/7 for your convenience.

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2021 Introducing Humana Healthy Horizons™ in FL

Details: Medicaid health plans. As of Apr. 1, 2021, Humana Florida Medicaid will be Humana Healthy Horizons in Florida. The new name reflects our goal not only to help our members achieve their best health and live their best lives, but also to give you the support you need to …

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2021 CarePlus Over-the-Counter (OTC) Products Mail-Order …

Details: and copy of your receipts to: CarePlus Health Plans, Inc., 11430 NW 20th Street, Suite 300, Miami, FL 33172 Attention: Member Services Department. You must submit your claim to us in writing within 12 months of the date you received the item or drug. Please review your Evidence of …

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MEDICAL PRECERTIFICATION REQUEST FORM

Details: The patient has a health condition that may seriously jeopardize his/her life or ability to regain maximum function. (Please include explanation of exigency in the space below.) Drug name and strength: Dose per infusion/injection: Directions/SIG: Number of infusions/injections:

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Consent for release of protected health information (PHI)

Details: health status or substance use or disorder records. This also includes sharing information on mail-order pharmacy, wellness products, and health programs with the person being authorized. q. Limited Disclosure: You specify what PHI to share. Ex. condition or …

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2021 List of Covered Drugs (Formulary)

Details: •Humana Gold Plus Integrated H0336-001 is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. •The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year.

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2021 CDT code changes

Details: systemic health effects associated with high-risk substance use Counseling services may include patient education about adverse oral, behavioral and systemic effects associated with high-risk substance use and administration routes. This includes ingesting, injecting, inhaling and vaping. Substances used in a high-risk manner may include but are

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EARNING POINTS in Go365

Details: Health Assessment Take your full Go365 Health Assessment online or on the App and earn Points for completing it for the first time each program year. 500 Health Assessment sections >> Get Active >> Eat Better >> Reduce Stress >> Live Well >> Know Your Health >> Introduce Yourself 200 bonus Points when you complete all six sections 50 Bonus Points

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Humana Preauthorization and Notification List

Details: Health care providers need to submit requests directly to Humana for medications listed on the Medicare and Dual Medicare-Medicaid Medication Preauthorization Drug List for all Humana MA HMO members in Florida. If Humana does not receive a …

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Humana’s Provider Networks

Details: Doctors and other health care practitioners selected for Humana’s networks go through a thorough credentialing process. The credentialing process is a way to verify the qualifications of doctors and other health care providers. The process includes checking education and training, licensure, board

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ORGANIZATIONAL PROVIDER CREDENTIALING APPLICATION

Details: health care programs in accordance with Sections 1128 or 1128A of the Social Security Act? B. Do you as a Provider have any agreements for the provisions of items or services related to the health plan's obligations under its contract with the Department of Human Services or the Centers for Medicare and

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Go365 Biometric Screening

Details: to improve health or prevent disease. 1 If you choose to participate in the wellness program you will be asked to complete a voluntary health assessment or “HA” that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease).

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2021 Health Plan Benefits at a Glance

Details: Mental Health Services With Medicare only In - Network With Medicare only Out-of-Network Inpatient psychiatric hospital Your plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. $240 copay per day for days 1-6 $0 copay per day for days 7-90 35% of the cost

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Humana Practitioner Assessment Form (PAF)

Details: The Humana Practitioner Assessment Form (PAF) is intended to guide a comprehensive health assessment. The form consists of elements from the Annual Wellness Visit (AWV), a physical exam and Healthcare Effectiveness Data and Information Set (HEDIS®) measures. The form can be used by physicians and other

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Health, Safety and Welfare Education Training

Details: Health, Safety and Welfare Education Training. Effective January 2021. Humana requires this training of all subcontractors supporting its contracts for Medicaid or Medicare- Medicaid programs, based on Humana’s applicable contractual and regulatory obligations to the states. LC7869MUL1020 (HUMP07869) GCHK2WYEN

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Medicare Advantage Preventive Services Tip Sheet Making It

Details: LC2118ALL0919-B GHHKNTZEN . Medicare Advantage Preventive Services Tip Sheet. Preventive services covered for Humana Medicare Advantage patients include

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2021 Provider and Pharmacy Directory

Details: Christian Community Health Center Group 364 Torrence Ave Calumet City, IL 60409 (773) 233-4100 Akaeze, Dorothy M NP NPI: 1649641747 License: IL 041358749 PCP# 226283 Medicaid Certified Handicap Accessible: Building, Parking, Restroom Public Transport: Bus, Regional Train

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Your 2021 Evidence of Coverage

Details: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Humana Gold Plus H4461-031 (HMO-POS) This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 - December 31, 2021.

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Identification (ID) cards

Details: A Medicare Health Plan MEMBER NAME Member ID: Plan (80840) 9140461101 Network: XXXXX CARD ISSUED: Copayments OFFICE VISIT: SPECIALIST: SXX HOSPITAL EMERGENCY: CMS XXXXX Member/Provider Service: Ifyou use a TTY, call 711 For Payment Terms and Conditions: Primary Physician: PROVIDERS: DO NOT BILL MEDICARE. 1-800-457-4708 1-866-291-9714

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TRICARE Other Health Insurance questionnaire

Details: Plans and 1086 Contracts for Health Benefits for Certain Members, Former Members, and Their Dependents; 38 U.S.C. Chapter 17 Hospital, Nursing Home, Domiciliary, and Medical Care; 32 CFR Part 199, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); and …

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Grievance & Appeal Form 2020

Details: Address: CarePlus Health Plans Fax Number: 1-800-956-4288 11430 NW 20th Street, Suite 300 Miami, Florida 33172 Attn: Grievance/Appeals Department If you need assistance with this form, please call Member Services at 1-800-794-5907; TTY: 711.From October 1 - March 31, we are open 7 days a week, 8 a.m. to 8 p.m. From April 1 -

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FLORIDA MEDICAID PROVIDER HANDBOOK

Details: Florida has offered Medicaid services since 1970. Medicaid provides health care coverage for income-eligible children, seniors, disabled adults and pregnant women. It is funded by both the state and federal governments and includes both capitated health plans as well as fee-for-service coverage. The Agency

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Population Insights Compass

Details: 1. Patient Detail Tab: Enables users to view a patient’s plan, demographic information and health indictors for better care mana gement 2. Search field: Enables users to search for an individual patient by name or Humana ID to view details related to the patient’s health 3.

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Author by Humana Provider Manual Appendix

Details: - Working with third-party vendors including New Century Health and Cohere Health - Reaching Author by Humana teams including Right Care (UM) or Behavioral Health Author by Humana Provider Navigators are available at 1-833-502-2013, 8 AM to 5 PM Eastern time,

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Kentucky Medicaid MCO Prior Authorization Request Form

Details: PASSPORT HEALTH PLAN BY MOLINA DEPARTMENT PHONE FAX/OTHER Use, Inpatient & EmailMedical, Behavioral Health, Substance Outpatient 1-800-578-0775 1-833-454-0641 www.Availity.com 1Medical, Behavioral Health, Substance Use Appeals -800 578 0075 866 315 2572 [email protected] www.Availity.com

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Consent for Release of Protected Health Information (PHI)

Details: CarePlus Health Plans, Inc. complies with applicable Federal Civil Rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender, gender identity, ancestry, marital status, or religion in their

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Substance use disorders

Details: Mental health problems and substance use disorders share some underlying causes. Some people with mental health problems may turn to ubstance use to self-medicate. Use of certain substances can cause people with addiction to experience mental health issues. Signs and symptoms Signs and symptoms are variable, depending on the

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Go365TM Activity completion form for blood glucose, blood

Details: GCHJLWKEN 0518 Page 3 of 5 biometric screening, only individuals who do so may be eligible to receive the Points associated with those activities.2 Additional Points are3 awarded for individuals who participate in health-related activities or achieve certain health outcomes. If you are unable to participate in any of the health-related activities or achieve any of the health outcomes required

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Humana Pharmacy Solutions Pharmacy Manual

Details: coverage determination if the member’s health would be placed in jeopardy by waiting the standard 72 hours under the prescription benefit or seven days under the medical benefit for a decision. However, requests for payment or reimbursement cannot be expedited. Members, prescribers and appointed or authorized representatives may request a

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Authorization Request Sleep Studies (PSG), Adult

Details: jeopardize the life or health of the particular enrollee or the enrollee’s ability to regain maximum function. Please call (866) 825-1550 for immediate handling or fax …

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Health, Safety and Welfare Education Training

Details: Health, Safety and Welfare Education Training Effective January 2021 Humana requires this training of all subcontractors supporting its contracts for Medicaid or Medicare-Medicaid programs, based on Humana’s applicable contractual and regulatory obligations to the states. LC7869MUL1020 (HUMP07869) GCHK2WYEN LC11009MUL0521

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JUNE UPDATE Humana’s COVID-19 response: An important

Details: Health and Human Services’ determination that a public health emergency exists is effective through Jul. 21, 2021 and may be renewed. Humana will continue to monitor federal and state declarations and requirements, and will continue to make disaster overrides available based on such requirements.

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Telehealth FAQ for providers

Details: telehealth policy in light of the COVID-19 public health emergency. At a minimum, Humana Medicare Advantage plans will always apply the same waivers CMS has announced for . CMS telehealth. We will also align with applicable federal and state-specific requirements. 1 for telehealth coverage for our commercial and Medicaid insurance products.

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Humana Healthy Horizons in Kentucky

Details: Humana Healthy Horizons in Kentucky is a Medicaid product of Humana Health Plan Inc. LC9969KY0221 (HUMP09969) KYHKNBWEN The following are some of the many clearing houses offering services to healthcare providers.

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HSA, HRA and FSA Sample eligible expenses

Details: Health Savings Account (HSA), Health Reimbursement Arrangement (HRA) and Flexible Spending Account (FSA) HumanaAccess.com GHC17403 0521 Page 1 of 5 The following are examples of IRS allowable and disallowed healthcare expenses for Health Savings Accounts (HSA), Health Reimbursement Arrangement (HRA) and Flexible Spending Accounts (FSA).

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Your 2021 Evidence of Coverage

Details: Your Medicare Health Benefits and Services as a Member of Humana Honor (PPO) This booklet gives you the details about your Medicare health care coverage from January 1 - December 31, 2021. It explains how to get coverage for the health care services you need. This is an important legal document. Please keep it in a safe place.

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Humana ChoiceCare Credentialing Application 6.2013

Details: health care programs in accordance with Sections 1128 or 1128A of the Social Security Act? B. Do you as a Provider have any agreements for the provisions of items or services related to the health plan's obligations under its contract with the Department of Human Services or the Centers for Medicare and

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Consent for release of protected health information (PHI)

Details: health status or substance use or disorder records. This also includes sharing information on mail-order pharmacy, wellness products, and health programs with the person being authorized. q Limited Disclosure: You specify what PHI to share. Ex. condition or …

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CareOne PLUS (HMO) H1019-006

Details: CareOne PLUS (HMO) offered by CarePlus Health Plans, Inc. Annual Notice of Changes for 2021 You are currently enrolled as a member of CareOne PLUS (HMO). Next year, there will be some changes to the plan's costs and benefits. This booklet tells about the changes.

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Provider Relations Representatives

Details: Kentucky Health Departments Rep: Stacy Tooley Email: [email protected] Phone: 502-595-9858 Prescribed Pediatric Extended Care (PPECs) Kidz Club – all locations (Bowling Green, Dixie, Erlanger, Lexington, Neighborhood House, Preston) Rep: Stacy Tooley Email: [email protected] Phone: 502-640-3565 LC6169KY0720-A (HUMP06169)

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Humana Medicaid: Authorization Request Form

Details: Humana Medicaid: Authorization Request Form Please complete all applicable fields and return via email or fax. Email: [email protected] Fax: 1‐833‐974‐0059 …

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